Deep Brain Stimulation procedures used to treat movement disorders are complex. Patient selection is done in conferences involving neurosurgeons, neurologists, and physical therapists. Surgical placement of electrodes is frequently challenging because targets of interest are absent or poorly visible with current imaging modalities, or because targets move due to intra-operative brain shift. It is a lengthy process performed typically in awake patients that requires expertise in neurology, electrophysiology, and functional neurosurgery. The post-surgical programming of the stimulator is an equally challenging and time consuming task, requiring a choice from among 4000 possible parameter combinations, usually arrived at through an iterative process spanning several visits to the neurologist. Building on our accomplishments over the last four years, the goals of this project are to: (1) automate as much as possible each step in this process;(2) create an integrated system that will transform the overall procedure from a process in which information must be communicated among the many actors to one in which all information will be available at the time and point of care, and tailored to the clinical task being performed;(3) field and test this system at Vanderbilt and at other sites and collaborate with these sites to establish one central repository for DBS that can be used by practitioners around the world;and (4) work with industrial partners to disseminate the system. PUBLIC HEALTH RELEVANCE: The goal of this project is to develop a system that will assist in the planning, placement, and programming phases of Deep Brain Stimulator procedures used to treat patients who suffer from movement disorders such as Parkinson's disease (PD) or essential tremor (ET).